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SCIE Report 40: Keeping personal budgets personal: learning from the experiences of older people, people with mental health problems and their carers

Assessment and resource allocation

Assessing risks

Very few personal budget holders could recall risk and safety issues being explicitly discussed as part of the assessment process, although a few carers noted that the safety of the person they supported had been discussed with them. The discussions with staff also revealed a mixed picture in terms of the consistency with which risk and safety issues were assessed. A number of the case study sites had produced written guidance for staff on risk management and in one site mental health staff noted that risk assessment was well managed. However, some staff said they did not explicitly talk to people using services about risks and were unsure about departmental guidance. It seemed that staff sometimes found it difficult to translate written guidance into practice, and/or that the guidance was linked to traditional care management systems and did not fit with the new personal budget systems being used.

For many staff it was not clear how they should include risk or safety issues in a self-assessment questionnaire if the person using services did not want them recorded in that document. This, in turn raised questions about 'ownership' of the document, especially if it was entirely self-completed. In most areas there did not appear to be clear protocols for linking risk assessment (at the assessment stage) and risk management (at the support planning stage). This was a particular concern where these stages of the personal budget process were being undertaken by different agencies. In the case study sites where personal budget assessments and support plans had to be approved by a panel, there appeared to be some confusion among staff about what was meant by 'risk', with some people using 'risks' to refer to financial or public relations risks to the LA, and others meaning risks to the safety of the personal budget holder and/or their carer. However, as the panel below highlights, councils were trying to address this.

The feedback from personal budget holders and staff highlights the need for:

clear guidance on how issues of risk and safety should be included in the assessment, including how to balance and record choice and safety concerns if personal budget holders and practitioners have a difference of view

explicit separation in the personal budget process of the mechanisms used to judge the risks to the LA (e.g. financial risk) and those used to assess the safety of the personal budget holder and their carer (if appropriate)

robust systems for linking risk assessment or safety issues raised at the assessment stage to risk management in the support planning stage, especially where these are undertaken by different agencies/staff.

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